OBJECTIVES: To determine whether trials of physical activity promotion based in primary care show sustained effects on physical activity or fitness in sedentary adults, and whether exercise referral interventions are more effective than other interventions.
DESIGN: Systematic review and meta-analysis of randomised controlled trials.
DATA SOURCES: Medline, CINAHL, PsycINFO, EMBASE, SPORTDiscus, Centre for Reviews and Dissemination, the Cochrane Library, and article reference lists.
REVIEW METHODS: Review of randomised controlled trials of physical activity promotion in sedentary adults recruited in primary care, with minimum follow-up of 12 months, reporting physical activity or fitness (or both) as outcomes, and using intention to treat analyses. Two reviewers independently assessed studies for inclusion, appraised risk of bias, and extracted data. Pooled effect sizes were calculated using a random effects model.
RESULTS: We included 15 trials (n=8745). Most interventions took place in primary care, included health professionals in delivery, and involved advice or counselling given face to face or by phone (or both) on multiple occasions. Only three trials investigated exercise referral. In 13 trials presenting self reported physical activity, we saw small to medium positive intervention effects at 12 months (odds ratio 1.42, 95% confidence interval 1.17 to 1.73; standardised mean difference 0.25, 0.11 to 0.38). The number needed to treat with an intervention for one additional sedentary adult to meet internationally recommended levels of activity at 12 months was 12 (7 to 33). In four trials reporting cardiorespiratory fitness, a medium positive effect at 12 months was non-significant (standardised mean difference 0.51, -0.18 to 1.20). Three trials of exercise referral found small non-significant effects on self reported physical activity at 12 months (odds ratio 1.38; 0.98 to 1.95; standardised mean difference 0.20, -0.21 to 0.61).
CONCLUSIONS: Promotion of physical activity to sedentary adults recruited in primary care significantly increases physical activity levels at 12 months, as measured by self report. We found insufficient evidence to recommend exercise referral schemes over advice or counselling interventions. Primary care commissioners should consider these findings while awaiting further trial evaluation of exercise referral schemes and other primary care interventions, with longer follow-up and use of objective measures of outcome.
OBJECTIVES: We conducted a meta-analysis summarizing the effects of interventions designed to increase physical activity among healthy adults.
METHODS: Our comprehensive searches located 358 reports eligible for inclusion. We used random-effects analyses to synthesize data, and we used meta-analytic analogues of regression and analysis of variance to examine potential moderator variables. We also explored moderator variable robustness and publication bias.
RESULTS: We computed meta-analytic results from studies comprising 99 011 participants. The overall mean effect size for comparisons of treatment groups versus control groups was 0.19 (higher mean for treatment participants than for control participants). This effect size is consistent with a mean difference of 496 ambulatory steps per day between treatment and control participants. Exploratory moderator analyses suggested that the characteristics of the most effective interventions were behavioral interventions instead of cognitive interventions, face-to-face delivery versus mediated interventions (e.g., via telephone or mail), and targeting individuals instead of communities. Participant characteristics were unrelated to physical activity effect sizes. Substantial between-studies heterogeneity remained beyond individual moderators.
CONCLUSIONS: Interventions designed to increase physical activity were modestly effective. Interventions to increase activity should emphasize behavioral strategies over cognitive strategies.
Background: Poor diet and lack of physical activity can worsen cardiovascular health, yet most Americans do not meet diet and physical activity recommendations. Purpose: To assist the U.S. Preventive Services Task Force in updating its previous recommendations by systematically reviewing trials of physical activity or dietary counseling to prevent cardiovascular disease. Data Sources: MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials (2001 to January 2010), experts, and existing systematic reviews. Study Selection: Two investigators independently reviewed 13 562 abstracts and 481 articles against a set of a priori inclusion criteria and critically appraised each study by using design-specific quality criteria. Data Extraction and Analysis: Data from 73 studies (109 articles) were abstracted by one reviewer and checked by a second reviewer. Random-effects meta-analyses were conducted for multiple intermediate health and behavioral outcomes. Data Synthesis: Long-term observational follow-up of intensive sodium reduction counseling showed a decrease in the incidence of cardiovascular disease; however, other direct evidence for reduction in disease morbidity is lacking. High-intensity dietary counseling, with or without physical activity counseling, resulted in changes of -0.3 to -0.7 kg/m(2) in body mass index (adiposity), -1.5 mm Hg (95% CI, -0.9 to -2.1 mm Hg) in systolic blood pressure, -0.7 mm Hg (CI, -0.6 to -0.9 mm Hg) in diastolic pressure, -0.17 mmol/L (CI, -0.09 to -0.25 mmol/L) (-6.56 mg/dL [CI, -3.47 to -9.65 mg/dL]) in total cholesterol level, and -0.13 mmol/L (CI, -0.06 to -0.21 mmol/L) (-5.02 mg/dL [CI, -2.32 to -8.11 mg/dL]) in low-density lipoprotein cholesterol level. Medium- and high-intensity counseling resulted in moderate to large changes in self-reported dietary and physical activity behaviors. Limitations: Meta-analyses for some outcomes had large statistical heterogeneity or evidence for publication bias. Only 11 trials followed outcomes beyond 12 months. Conclusion: Counseling to improve diet or increase physical activity changed health behaviors and was associated with small improvements in adiposity, blood pressure, and lipid levels. Primary Funding Source: Agency for Healthcare Research and Quality.
'Exercise on Prescription' (EoP) is used for initiating physical activity among sedentary patients with signs of lifestyle diseases. EoP is personalized secondary prevention in primary healthcare. This review addresses EoP using a Health Technology Assessment perspective and aims to answer the following questions: (1) Does EoP increase physical activity level or physical fitness, and is more intensive EoP more effective than less intensive? (2) Is EoP acceptable and feasible in general practice? (3) Is EoP acceptable to and feasible for sedentary patients? (4) Is EoP cost-effective? EoP studies were searched using Medline thesaurus topic, Medline WinSPIRS, reference lists of recent reviews, and NLM Gateway Locator plus. A total of 22 studies were included in the review. Most studies reported moderate improvements in physical activity or physical fitness for 6-12 months. Among patients receiving EoP 10% more had improved physical activity level compared with controls and mean aerobic fitness was improved by 5-10% among EoP patients compared with controls. Little evidence existed in support of the hypthesis that more intensive EoP is more effective. EoP was acceptable and feasible to GPs and patients volunteering for EoP. However, little is known about non-completers, patients declining EoP, and GPs not highly motivated for using EoP. Only one study addressed health economic issues. It found EoP cost-effective, but comparisons with other interventions have not been performed. Even though most studies in this review presented favourable results for EoP there is a lack of evidence in several fields. In particular we lack high-quality studies evaluating EoP schemes that are sustainable in everyday use in general practice.
OBJECTIVE: To examine the physical activity (PA) counseling literature in primary care in order to identify which intervention provider has been used to date and their relative effectiveness for increasing PA. METHOD: MEDLINE and PsycINFO databases were searched for PA intervention studies in primary care settings. RESULTS: Of the 19 studies, 37% were conducted solely by physicians, 37% by allied health professionals, while 26% were combined-provider interventions. There was a decline in the number of physician-only interventions and a shift towards interventions offered by allied health professionals as adjuncts or alone. Interventions across all provider categories generated some improvements in physical activity behavior, however, it appears that allied health professionals as adjuncts or alone produced the best results in the long-term (>6 months). There was substantial variation in the location and counseling approach employed by allied health professionals. CONCLUSION: We argue for an interdisciplinary model in which physicians recommend PA and provide referrals to allied health professionals such as physical activity counselors. Practice implications: With physical activity counselors' specialized training and greater time available to the patient, they may provide more intensive and effective counseling required for behavior change and maintenance. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
BACKGROUND: To systematically review the literature concerning the effect of stages-of-change-based interventions in primary care on smoking, physical activity, and dietary behavior. METHODS: An extensive search (until July 2002) was performed using the following inclusion criteria: (1) (randomized) controlled trial (RCT/CT), (2) intervention initiated in primary care, (3) and intervention aimed at changing smoking, physical activity, or dietary behavior, and stages-of-change-based outcomes, and (4) behavioral outcomes. Methodologic quality was assessed, and conclusions on the effectiveness at short-, medium-, and long-term follow-up were based on a rating system of five levels of evidence. Odds ratios were calculated when methodologically appropriate. RESULTS: A total of 29 trials were selected for inclusion. Thirteen studies included a physical activity intervention, 14 aimed at smoking cessation, and five included a dietary intervention. Overall methodologic quality was good. No evidence was found for an effect on stages of change and actual levels of physical activity. Based on the strength of the evidence, limited to no evidence was found for an effect on stages of change for smoking and smoking quit rates. Odds ratios for quitting smoking showed a positive trend. Strong evidence was found for an effect on fat intake at short- and long-term follow-up. Limited evidence was found for an effect on stages of change for fat intake at short-term follow-up. CONCLUSIONS: The scientific evidence for the effect of stages-of-change-based lifestyle interventions in primary care is limited. Limiting aspects in the stages-of-change concept with respect to complex behaviors as physical activity and dietary behavior are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
AIM: To determine whether interventions undertaken with patients in primary care settings can be effective in increasing their physical activity participation. METHODS: A systematic review of physical activity intervention studies was conducted. Studies included were those undertaken with adul t primary care patients which used a randomised controlled trial (RCT) or controlled quasi - experimental design and reported physical activity participation as a primary outcome. The methodological quality of studies was appraised using the criteria develop ed by the United States Preventive Services Task Force and the potential public health impact of the interventions tested was assessed using the RE - AIM model. RESULTS: Twenty studies were included in the review. In eight studies physical activity was addr essed as part of a multiple risk factor intervention, and these included a total of 17565 subjects. Six of these studies were RCTs but all were given a methodological rating of ‘fair’. Twelve studies tested interventions focused solely on physical activity , with 7984 subjects enrolled in total. Eight of these were RCTs, two of which were given a methodological rating of ‘good’ while the remainder were given a rating of ‘fair’. The two multiple risk factor intervention studies which measured short - term effec ts reported significant outcomes, and four of the seven measuring long - term effects found significant improvements in physical activity. Six of the eight studies testing single risk factor interventions which measured short - term outcomes reported significa nt improvements in physical activity. Three of the six studies which undertook medium - term follow - up found significant effects while two of the five which undertook long - term follow - up reported significant outcomes. The small number and diverse nature of the interventions associated with increases in physical activity made it difficult to identify the characteristics of interventions that were associated with a greater likelihood of producing increases in physical activity. Brief and intensive intervention s appeared to be equally effective and the greatest effects were achieved when interventions were targeted to the sedentary or insufficiently active. Appraisal of the public health significance of this literature was undertaken to determine whether these interventions should be recommended to public health policy makers. It was found that most studies used selected samples and that few provided data to enable assessment of the generalisability of study findings, hence the applicability of the findings to t he wider population was not known. Furthermore, few interventions have been tested which could be readily implemented in routine primary care settings. CONCLUSIONS: There is evidence of ‘fair’ quality that interventions conducted with primary care patient s which address physical activity alone can achieve improvements in this behaviour. In light of this limited evidence, a reasonable approach for primary care practitioners to adopt is to undertake brief interventions with inactive patients who have health conditions which could be reduced by physical activity participation. Interventions in primary care will not be sufficient to increase physical activity levels in the population and need to be incorporated within multi - faceted, community - wide strategies to address this risk factor
PURPOSE: To determine whether counseling adults in primary care settings improves and maintains physical activity levels.
DATA SOURCES: The Cochrane Database of Systematic Reviews and Registry of Controlled Trials and the MEDLINE, HealthStar, and Best Evidence databases were searched for papers published from 1994 to March 2002.
STUDY SELECTION: Controlled trials, case-control studies, and observational studies that examined counseling interventions aimed at increasing physical activity in general primary care populations were reviewed. The researchers included trials in which 1) a patient's primary care clinician performed some of the counseling intervention; 2) behavioral outcomes (physical activity) were reported; and 3) the study was of "good" or "fair" quality, according to criteria developed by the U.S. Preventive Services Task Force.
DATA EXTRACTION: Data were abstracted on design and execution, quality, providers, patients, setting, counseling intervention, and self-reported physical activity at follow-up.
DATA SYNTHESIS: Eight trials involving 9054 adults met the inclusion criteria. Among six controlled trials with a usual care control group, the effects of counseling on physical activity were mixed. Because most studies had at least one methodologic limitation, it was difficult to rigorously assess the efficacy of the interventions. More research is needed to clarify the effect, benefits, and potential harms of counseling patients in primary care settings to increase physical activity.
CONCLUSION: Evidence is inconclusive that counseling adults in the primary care setting to increase physical activity is effective.
To determine whether trials of physical activity promotion based in primary care show sustained effects on physical activity or fitness in sedentary adults, and whether exercise referral interventions are more effective than other interventions.
DESIGN:
Systematic review and meta-analysis of randomised controlled trials.
DATA SOURCES:
Medline, CINAHL, PsycINFO, EMBASE, SPORTDiscus, Centre for Reviews and Dissemination, the Cochrane Library, and article reference lists.
REVIEW METHODS:
Review of randomised controlled trials of physical activity promotion in sedentary adults recruited in primary care, with minimum follow-up of 12 months, reporting physical activity or fitness (or both) as outcomes, and using intention to treat analyses. Two reviewers independently assessed studies for inclusion, appraised risk of bias, and extracted data. Pooled effect sizes were calculated using a random effects model.
RESULTS:
We included 15 trials (n=8745). Most interventions took place in primary care, included health professionals in delivery, and involved advice or counselling given face to face or by phone (or both) on multiple occasions. Only three trials investigated exercise referral. In 13 trials presenting self reported physical activity, we saw small to medium positive intervention effects at 12 months (odds ratio 1.42, 95% confidence interval 1.17 to 1.73; standardised mean difference 0.25, 0.11 to 0.38). The number needed to treat with an intervention for one additional sedentary adult to meet internationally recommended levels of activity at 12 months was 12 (7 to 33). In four trials reporting cardiorespiratory fitness, a medium positive effect at 12 months was non-significant (standardised mean difference 0.51, -0.18 to 1.20). Three trials of exercise referral found small non-significant effects on self reported physical activity at 12 months (odds ratio 1.38; 0.98 to 1.95; standardised mean difference 0.20, -0.21 to 0.61).
CONCLUSIONS:
Promotion of physical activity to sedentary adults recruited in primary care significantly increases physical activity levels at 12 months, as measured by self report. We found insufficient evidence to recommend exercise referral schemes over advice or counselling interventions. Primary care commissioners should consider these findings while awaiting further trial evaluation of exercise referral schemes and other primary care interventions, with longer follow-up and use of objective measures of outcome.
